Medicare OIG Exclusion

Medicare exclusion will have devastating effects for you and your practice. Once you have been notified that you are excluded from Medicare, you must cease billing all Federally funded health programs and consult with an experienced Medicare exclusion attorney.

Reasons for Medicare Exclusion

You can be excluded from Medicare for a variety of reasons outlined in 42 U.S.C. §1320a-7. Some Felony convictions can result in Medicare exclusion, especially those arising from health care fraud, or the unlawful manufacture, distribution, or prescription of dispensing controlled substances (dug trafficking). You can also be excluded from Medicare for a misdemeanor conviction related to obstruction of an investigation or controlled substances. State professional license suspension can also result in Medicare exclusion. Additionally, any individual who has engaged in fraud, kickbacks, and/or Stark violations can be excluded whether it results in a conviction or not.

If you are a physician, dentist, physician assistant, pharmacist, chiropractor, or other licensed health professional, and you have been excluded from Medicare or believe you could be excluded from Medicare, it is imperative that you contact an experienced Medicare exclusion attorney today to discuss the possibility of appeal. You only have sixty (60) days from your notice of Medicare exclusion to appeal the HHS Office of Inspector General (OIG) decision.

How To Appeal Medicare Exclusion Decision

Given that Medicare exclusion is virtually career ending, if you are excluded from Medicare, you should appeal your Medicare exclusion by requesting a hearing before an Administrative Law Judge. Just like reinstatement, you essentially have one (1) shot at an appeal, and you should consider hiring a Medicare exclusion reinstatement attorney to appeal the Medicare exclusion decision. Pursuant to 42 CFR 402.214, you must request a hearing within sixty (60) days from the receipt of the notice of exclusion. The request for a Medicare exclusion hearing should be completed by an experienced health law attorney and must include:

1. A statement as to the specific issues the individual takes with the Medicare exclusion;
2. Basis for the disagreement of the Office of Inspector General’s decision;
3. Reasons why the proposed length of exclusion should be modified;
4. Reasons, if applicable, why the health or safety of Medicare beneficiaries does not warrant exclusion.

If you do not file a timely request for a hearing, you lose your right to appeal. Therefore, it is imperative that you file your request for a Medicare exclusion hearing within sixty (60) days ensure that it contains all of the necessary elements. Failure to properly petition for a Medicare exclusion hearing will result in loss of your right to appeal. If you are granted a hearing, your attorney will be able to present arguments to an Administrative Law Judge and seek reinstatement. If the Medicare exclusion was in error, you will be reinstated.

How to Apply for Medicare Reinstatement

Medicare reinstatement is not automatic. If you have been notified of exclusion from Medicare by the HHS Office of Inspector General (OIG), you must understand that you are prevented from working for any individual or entity that contracts with Medicare, Tricare, or other Federally funded programs until you receive notice of reinstatement. If a health care provider is excluded from Medicare, he/she can re-apply within ninety (90) days of the expiration of the Medicare exclusion. It can take up to six (6) months or more for the OIG to rule on your Medicare reinstatement application. Therefore, you only have one (1) good shot to submit the best application possible, and should consider hiring a Medicare exclusion reinstatement attorney to assist you.

To apply for Medicare reinstatement, you must send a written request to the OIG and provide a statement with the relevant authorization forms. The information in your statement and forms will be evaluated and the OIG will send you written notification of their decision, which could take up to one-hundred-twenty (120) days or longer. Therefore, it is imperative that you put your best foot forward in your Medicare exclusion reinstatement application and statement.

If the OIG denies your Medicare reinstatement application, you will not be able to apply for Medicare reinstatement for one (1) calendar year.

Our Experience

Our attorneys at Chapman Law Group defend providers nationwide during Medicare exclusion and Medicare reinstatement proceedings and can guide you through every step to ensure that you have the best possible chance at reinstatement. Our Medicare exclusion attorneys are familiar with what information the OIG will want to see in your statement to improve your chances of a favorable Medicare reinstatement decision.

For over 25 years’, Chapman Law Group has been dedicated to the defense of health care professionals. Our attorneys have thirty-plus (30+) years of experience in defending health professionals during criminal, administrative, civil proceedings, including Medicare reinstatement and Medicare exclusion hearings.